06/03/2026
Are all generic equivalents actually the same?
The FDA is responsible for making sure that generic manufacturers make an equivalent product through review of what is called an “Abbreviated New Drug Application” or ANDA and follow up inspections, some mandated reporting, and public comments/complaints. It’s a system that has worked, at minimum, fairly well for decades with a long history of generic price deflation and high quality products that have saved millions of lives. We also have evidence of fraudulent ANDAs, scheduled inspections that don’t find evidence of low quality manufacturing, a litany of medication recalls, and many many patient stories of switching between generics and having something unexpected happen.
This isn’t the place to argue about the FDA or pharma or multinational companies but it does make sense to introduce the second way a generic medication comes to market.
A small number of generic medications don’t have an ANDA, instead the brand name manufacturer tells the FDA “hey we’re going to sell our brand name product that you approved a long time ago as a generic.” These are called “Authorized Generics” and they are the exact same products as the brand name “reference product” that went through probably a decade of clinical study and development before launching.
In pharmacies that sell medications to insurance plans, being thoughtful about potential sourcing and quality concerns and leveraging Authorized Generics isn’t really a possibility. The industry runs on “lowest cost available” so paying a slight premium to attempt to maximize quality isn’t really a choice. In our direct-pay model where we sell medications to people (you! Our patients!) we can have the conversation and increasingly we are just doing it.
Pictured here are two generic steroid packs, the FDA says they are AB rated and interchangeable, effectively they are the same. But the one on the right is the Authorized Generic of Pfizer’s Medrol, the tablets literally say Medrol on them. We chose in the last few weeks to transition to just using the Authorized Generic in this case. Best part, our price to our patients is $11.95 either way. Win-Win! We’re out about $0.30/pack but you know what, we think it’s worth it to deliver the highest quality product.
We’d love to hear stories about how switching generics has impacted you. We’re also curious to explore how much additional one might be willing to pay for a potentially higher quality product in the prescription space (remember we don’t actually know, just making an educated guess!). Share your thoughts here or in messages or in person! Thanks!
If you want to learn more about this space: Katherine Eban’s book Bottle of Lies is a fascinating deep dive into the generic drug supply chain.
